U.S. patent application number 13/968253 was filed with the patent office on 2014-02-20 for anatomical model and method for surgical training.
This patent application is currently assigned to Intuitive Surgical Operations, Inc.. The applicant listed for this patent is Intuitive Surgical Operations, Inc.. Invention is credited to Anthony M. JARC, Eugene T. NAGEL, Christopher J. SANCHEZ, Timothy V. WHITE.
Application Number | 20140051049 13/968253 |
Document ID | / |
Family ID | 50100285 |
Filed Date | 2014-02-20 |
United States Patent
Application |
20140051049 |
Kind Code |
A1 |
JARC; Anthony M. ; et
al. |
February 20, 2014 |
ANATOMICAL MODEL AND METHOD FOR SURGICAL TRAINING
Abstract
Implementations relate to anatomical models and surgical
training. In some implementations, an anatomical training model
includes a base portion and a top portion that form a hollow space
between the base portion and top portion. A plurality of holes are
positioned in the top portion. The model includes a plurality of
cannula supports, where each cannula support is aligned with one or
more corresponding holes in the top portion.
Inventors: |
JARC; Anthony M.;
(Cupertino, CA) ; SANCHEZ; Christopher J.;
(Mountain View, CA) ; WHITE; Timothy V.;
(Scottsdale, AZ) ; NAGEL; Eugene T.; (Scottsdale,
AZ) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Intuitive Surgical Operations, Inc. |
Sunnyvale |
CA |
US |
|
|
Assignee: |
Intuitive Surgical Operations,
Inc.
Sunnyvale
CA
|
Family ID: |
50100285 |
Appl. No.: |
13/968253 |
Filed: |
August 15, 2013 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
61684376 |
Aug 17, 2012 |
|
|
|
Current U.S.
Class: |
434/267 |
Current CPC
Class: |
G09B 23/285 20130101;
G09B 23/30 20130101 |
Class at
Publication: |
434/267 |
International
Class: |
G09B 23/30 20060101
G09B023/30 |
Claims
1. An anatomical training model comprising: a base portion; a top
portion coupled to the base portion to form a hollow space between
the base portion and the top portion, the top portion including a
plurality of holes; and a plurality of cannula supports, each
cannula support being aligned with one or more corresponding holes
of the plurality of holes in the top portion.
2. The anatomical training model of claim 1 wherein the plurality
of holes are greater in number than required by surgical procedures
using the anatomical training model.
3. The anatomical training model of claim 1 wherein at least one of
the plurality of holes has one size to accommodate one size of
instrument cannula, and at least one of the plurality of holes has
a different size to accommodate a different size of instrument
cannula.
4. The anatomical training model of claim 1 wherein the plurality
of cannula supports include at least one cannula support piece
positioned below one or more of the corresponding holes and above
the bottom portion to simulate a patient body wall for one or more
instruments inserted through at least one of the holes in the top
portion.
5. The anatomical training model of claim 1 wherein each of the
plurality of cannula supports is positioned in a corresponding one
of the plurality of holes in the top portion.
6. The anatomical training model of claim 5 wherein each of the
cannula supports includes a flexible piece including an annular
membrane for holding at least one cannula inserted through the
cannula support and the corresponding hole.
7. The anatomical training model of claim 1 further comprising a
membrane positioned over the top portion and the plurality of
holes.
8. The anatomical training model of claim 1 wherein the base
portion includes a platform providing at least one surgical site to
receive one or more instruments inserted in one or more
corresponding holes in the top portion.
9. The anatomical training model of claim 8 wherein the at least
one surgical site is provided at a known position and orientation
on the platform with respect to the plurality of holes to act as a
fixed registration location for placement of one or more cannulas
in one or more of the plurality of holes.
10. The anatomical training model of claim 8 wherein the platform
is removable from the base portion.
11. The anatomical training model of claim 8 wherein the platform
includes a plurality of structures at different locations of the
platform to which the at least one surgical site is operative to be
attached, allowing varied positional placement of the at least one
surgical site with respect to the plurality of holes in the top
portion.
12. The anatomical training model of claim 1 wherein the at least
one surgical site includes at least one of: a component having a
soft material simulating tissue for surgical manipulating tasks;
and a component having a curved pathway and one or more pieces
moveable along the curved pathway.
13. An anatomical training model comprising: a base portion
including a removable platform providing at least one surgical
site; a top portion coupled to the base portion to form a hollow
space between the base portion and the top portion, the top portion
including a plurality of holes each sized to receive one or more
cannulas directed toward the surgical site.
14. The anatomical training model of claim 13 wherein the at least
one surgical site is provided at a known position and orientation
on the platform with respect to the plurality of holes to act as a
fixed registration location for placement of one or more cannulas
in one or more of the plurality of holes.
15. The anatomical training model of claim 13 wherein the platform
includes a plurality of structures at different locations of the
platform to which the at least one surgical site is operative to be
attached, allowing varied positional placement of the at least one
surgical site with respect to the plurality of holes in the top
portion.
16. A surgical training method comprising: measuring one or more
parameters associated with one or more tasks, wherein the one or
more tasks are performed with reference to an anatomical model and
include at least one of: surgical instrument port placement,
surgical robot arm setup, and cannula docking; performing an
automatic comparison between the measured one or more parameters
and corresponding one or more stored parameters associated with the
one or more tasks; and outputting an evaluation that is based on
the automatic comparison.
17. The surgical training method of claim 16 wherein the
corresponding one or more stored parameters are measured at a first
time, and the measuring of the one or more parameters is performed
at a second time later than the first time.
18. The surgical training method of claim 17 wherein the one or
more parameters measured at the first time are associated with a
first person performing the one or more tasks, and wherein the one
or more parameters measured at the second time are associated with
a second person performing the one or more tasks.
19. The surgical training method of claim 17 wherein the one or
more parameters measured at the first time and the second time are
associated with a particular person performing the one or more
tasks the first time and the second time.
20. The surgical training method of claim 16 wherein outputting an
evaluation includes outputting a score is based on one or more of:
the time needed to perform the one or more tasks, and positioning
or movement of surgical procedure components during the one or more
tasks.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims priority to U.S. Provisional
Application No. 61/684,376, filed Aug. 17, 2012, and which is
incorporated herein by reference in its entirety.
COPYRIGHT NOTICE
[0002] A portion of the disclosure of this patent document contains
material which is subject to copyright protection. The copyright
owner has no objection to the facsimile reproduction by anyone of
the patent document or the patent disclosure, as it appears in the
Patent and Trademark Office patent file or records, but otherwise
reserves all copyright rights whatsoever.
BACKGROUND
[0003] Disclosed features concern medical training equipment and
methods, and more particularly medical training equipment and
methods used for training in minimally invasive surgical procedures
and techniques.
[0004] Minimally invasive surgical instrument port placement in a
patient's anatomy, setup positioning of a minimally invasive
surgical robotic system, and coupling the robotic system to
cannulas positioned in the ports ("docking" the robot to the
cannulas) are important tasks for surgeons and medical personnel to
learn. Physical anatomic models dedicated for use in training these
tasks or that provide standardized ways to evaluate these tasks do
not exist. Current anatomical simulation models (e.g., from the
Chamberlain Group, Limbs & Things LTD, Pacific Research
Laboratories, Inc. (Sawbones.RTM.), ProMIS.TM. Simulator from CAE
Healthcare of CAE, Inc., SimSurgery.RTM. SEP products, and the
like) may simulate a portion of an abdomen, but such models do not
provide features associated with these tasks or the necessary
standardization required to measure performance parameters over
time and populations. In some cases, for example, port locations on
traditional laparoscopic models may not be appropriate for robotic
surgery. Furthermore, many of the existing models have instrument
handles (such as laparoscopic tool handles) rigidly attached to
port locations so that robotic trocars or other components cannot
be attached to the ports.
[0005] The solutions developed thus far have not been specifically
targeted to robotic surgery and instead have tried to encompass
general surgery, laparoscopic surgery, and to a limited extent
robotic surgery. This lack of dedicated robotic surgical training
equipment has led to training exercises that are not ideally suited
for the unique considerations of robotic surgery. For example, most
other systems use a "skin" to lay over large openings in an abdomen
model, and port locations must be placed through this large piece
of skin. This situation often leads to only a single set of holes
and lack of instruction through different choices, setups, etc.
Students are not provided the opportunity to try various port
placement patterns and to learn the benefits and disadvantages of
specific patterns vis-a-vis a particular surgical task to be
performed.
[0006] During training to use a minimally invasive surgical system,
many surgeons and medical personnel initially have difficulty with
port placement, robot setup, and cannula docking tasks, and such
difficulty may needlessly extend operating times and may even
affect a surgeon's willingness to adopt such technology. In
addition, personnel associated with training these tasks have
identified a lack of proficiency in port placement and cannula
docking as the major limiter for useful training outside of a
dedicated training facility, such as at a hospital location. What
is needed is dedicated training equipment and associated procedures
to help surgeons and other medical personnel become proficient in
these and related tasks.
SUMMARY
[0007] Implementations of the present application relate to
anatomical models and surgical training using such a model. In some
implementations, an anatomical training model includes a base
portion and a top portion that form a hollow space between the base
portion and top portion. A plurality of holes are positioned in the
top portion. The model includes a plurality of cannula supports,
where each cannula support is aligned with one or more
corresponding holes in the top portion. For example, each cannula
support can be configured to hold a cannula that is positioned
through the hole, in simulation of the various locations in a
patient's body wall at which cannulas may be placed.
[0008] Various implementations of the model are described. In some
examples, the plurality of holes are greater in number than
required by surgical procedures using the model. At least one of
the plurality of holes can have one size to accommodate one size of
instrument cannulas, and at least one of the plurality of holes can
have a different size to accommodate a different size of instrument
cannulas. In some implementations, the cannula supports include at
least one cannula support piece positioned below one or more of the
corresponding holes and above the bottom portion to simulate a
patient body wall for one or more instruments inserted through at
least one of the holes in the top portion. In other
implementations, each of the cannula supports is positioned in a
corresponding one of the plurality of holes in the top portion. For
example, each of the cannula supports can include a flexible piece
including an annular membrane for holding a cannula inserted
through the cannula support and the corresponding hole. Some
implementations can include a membrane positioned over the top
portion and the plurality of holes.
[0009] The base portion of the anatomical model can include a
platform providing at least one surgical site to receive one or
more instruments inserted in one or more corresponding holes in the
top portion. The platform can be removable from the base portion in
some implementations. The surgical site can be provided at a known
position and orientation on the platform with respect to the
plurality of holes to act as a fixed registration location for
placement of one or more cannulas in one or more of the plurality
of holes. For example, the platform can include structures at
different locations of the platform to which the surgical site is
operative to be attached, allowing varied positional placement of
the at least one surgical site with respect to the plurality of
holes in the top portion. The at least one surgical site can
include, for example, a component having a soft material simulating
tissue for surgical manipulating tasks, and/or a component having a
curved pathway and one or more pieces moveable along the curved
pathway.
[0010] In some implementations, an anatomical training model
includes a base portion including a removable platform providing at
least one surgical site, and a top portion coupled to the base
portion to form a hollow space between the base portion and the top
portion. The top portion includes a plurality of holes each sized
to receive one or more cannulas directed toward the surgical site.
In various implementations, the surgical site can be provided at a
known position and orientation on the platform with respect to the
plurality of holes to act as a fixed registration location for
placement of one or more cannulas in one or more of the plurality
of holes. The platform can include structures at different
locations of the platform to which the at least one surgical site
is operative to be attached, allowing varied positional placement
of the surgical site with respect to the plurality of holes in the
top portion.
[0011] In some implementations, a surgical training method includes
measuring one or more parameters associated with one or more tasks,
where the one or more tasks are performed with reference to an
anatomical model and include at least one of: surgical instrument
port placement, surgical robot arm setup, and cannula docking. An
automatic comparison is performed between the measured one or more
parameters and corresponding one or more stored parameters
associated with the one or more tasks, and an evaluation is output
that is based on the automatic comparison. In various
implementations, the corresponding stored parameters are measured
at a first time, and the measuring of the parameters is performed
at a second time later than the first time. The parameters measured
at the first time can be associated with a first person performing
the tasks, and the parameters measured at the second time can be
associated with a second person performing the one or more tasks.
Alternatively, the parameters measured at the first time and the
second time can be associated with a particular person performing
the tasks. Outputting an evaluation can include outputting a score
that is based on the time needed to perform the one or more tasks,
and/or positioning or movement of surgical procedure components
during the tasks.
BRIEF DESCRIPTION OF THE DRAWINGS
[0012] FIG. 1 is a perspective view of an anatomical model;
[0013] FIGS. 2A and 2B are a diagrammatic perspective views that
illustrates surgical ports and associated cannula supports in an
anatomical model;
[0014] FIG. 3A is a perspective view of a cannula support;
[0015] FIGS. 3B and 3C are perspective views of a cannula support
and single site port;
[0016] FIG. 4 is top perspective view of an anatomical model;
[0017] FIG. 5 is a diagrammatic top view of port placement
grids;
[0018] FIG. 6 is a perspective view of a surgical robot with an
anatomical model;
[0019] FIG. 7 is a perspective view of one example of a surgical
exercise task platform;
[0020] FIG. 8 is a perspective view of another example of a
surgical exercise task platform;
[0021] FIG. 9 is a perspective view of one example of an anatomical
model base portion and a surgical exercise task platform;
[0022] FIG. 10 is a perspective view of another example of the
anatomical model and a platform similar to the platform of FIG.
8;
[0023] FIG. 11 is a perspective view of an interior of one
embodiment of an anatomical model;
[0024] FIG. 12 is a perspective view of one example of an
illustrative task exercise component for a platform similar to the
platform of FIG. 8;
[0025] FIGS. 13A to 13H show example illustrative task exercise
components which can be used for the platform in the anatomical
model;
[0026] FIG. 14 is a flow chart that illustrates an example method
for evaluating patient-side surgical task exercises;
[0027] FIG. 15 is a flow chart that illustrates an example method
for evaluating surgical task operations; and
[0028] FIG. 16 is a diagrammatic view of an example system for
performing surgical exercise tasks and evaluation.
DETAILED DESCRIPTION
[0029] The present application discloses features relating to
anatomical models used in surgical procedure training exercises,
and relating to methods evaluating performances of surgical
procedures using an anatomical model. Various disclosed
implementations of anatomical models provide and teach realistic
positioning, placement, and use of cannula ports and surgical sites
for particular surgical procedures. The anatomical model provides a
known configuration to be used for surgical training, including
positioning cannula ports and surgical sites at known, consistent
locations. Implementations provide consistent and repeatable
surgical task exercises to allow standardized and consistent
measurement, evaluation, and comparison of performances of surgical
techniques by many different trainees. Disclosed training methods
include measurement and evaluation of surgical exercise tasks such
as port placement, robot setup, cannula docking tasks, and surgical
task operations, allowing trainees' performances to be evaluated
and enabling trainees to improve their skills more efficiently.
[0030] Some implementations are described using a robotic surgery
system such as a da Vinci.RTM. Surgical System (e.g., a Model
IS3000, marketed as the da Vinci.RTM. Si.TM. HD.TM. Surgical
System), commercialized by Intuitive Surgical, Inc. of Sunnyvale,
Calif. Knowledgeable persons will understand, however, that
features disclosed herein may be embodied and implemented in
various ways, including robotic and, if applicable, non-robotic
embodiments and implementations. Implementations on da Vinci.RTM.
Surgical Systems (e.g., the Model IS3000; the Model IS2000,
commercialized as the da Vinci.RTM. S.TM. HD.TM. Surgical System)
are merely exemplary and are not to be considered as limiting the
scope of the inventive aspects disclosed herein.
[0031] FIG. 1 is a perspective view of an anatomical model 101 in
accordance with some implementations disclosed herein. As shown,
the model resembles an insufflated human abdomen and pelvic region.
For example, the size and shape of the model 101 can be determined
from values in medical literature and cadaver measurements. Various
embodiments of model 101 may be sized differently to simulate
various body sizes (e.g., pediatric, small female, average, large
male, obese, etc.).
[0032] The model includes a top portion 102a and a base portion
102b, which fit together and form an outer shell of the model. The
model has a hollow interior between top portion 102a and base
portion 102b. Alternatively, the outer shell of the model is formed
from a single piece, or from three or more pieces.
[0033] Several port placement openings are formed in the top
portion 102a of the model, and these openings allow one or more
cannulas to be positioned in the model at various port locations.
As shown in the example embodiment of FIG. 1, the openings can
include one or more sets of holes in top portion 102a to allow
operating instrument cannulas to pass therethrough and directed
instruments toward a surgical site inside the anatomical model 101.
In this example, one set of holes 103 is positioned in top portion
102a to accommodate cannulas for surgical instruments that are
operating instruments, e.g., instruments used to contact and
manipulate a simulated surgical site within the model. For example,
operating instruments can include conventional laproscoping
instruments and/or instruments having manipulable needle driver,
stapler, scalpel, vessel sealer, scissors, forceps, grasping
implements, cauterizing tools, irrigation tools, suction tools,
etc. A second set of holes 104 are also positioned in top portion
102a to accommodate cannulas for surgical instruments that are
endoscopes or other camera instruments, e.g., instruments providing
a camera and/or illumination to provide images of the surgical site
to the surgeon or trainee. In some implementations, smaller camera
instruments can be positioned through the smaller holes 103.
[0034] In this example, holes 104 can be positioned along a
longitudinal centerline of the top portion 102a, in accordance with
an aspect of a camera port placement technique that similarly
positions the camera instrument port generally at a patient's
abdominal centerline. In other embodiments, holes 104 may be at
other locations in the model. As shown, holes 103 are positioned in
top portion 102a laterally of the model's longitudinal centerline.
Holes 103 simulate the various locations at which operating
instrument cannulas can be placed.
[0035] The various holes are placed to allow a trainee to place
surgical instrument ports in the model in accordance with
recommended surgical instrument port placement for various robotic
surgery procedures, such as radical prostatectomy, radical
hysterectomy, partial nephrectomy, multi- or single-port
cholecystectomy, etc. In some embodiments, one or more holes 103
and/or 104 are placed in base portion 102b to simulate access to a
surgical site from a direction that originates at base portion
102b. The holes 103,104 can be placed at various locations in
various embodiments to accommodate the learning objective or
objectives to be supported by the use of the particular model
embodiment. In various implementations, the density and/or number
of holes in top portion 102a can vary to allow for more or fewer
port location options.
[0036] In some implementations such as the embodiment shown, there
can be a greater number of holes 103,104 provided in the top
portion 102a than are required for a surgical procedure (or any
surgical procedures intended to be practiced using the model), so
that a trainee is required to select the proper subset of holes to
use in order to reach a surgical site inside the simulated patient.
Thus, various port placements can be explored for a certain
surgical task. In this way a surgeon can more fully understand the
relative advantages and disadvantages of one port placement
strategy versus another port placement strategy for a certain
surgical task.
[0037] Furthermore, the anatomical model 101 provides an array of
holes 103 and 104 which can be specifically-tailored in their
positions to surgical instruments of a particular robotic surgical
system, allowing training to be provided for a robotic system using
an array of port locations.
[0038] A simulated surgical site platform 106 can be positioned
inside the model's hollow interior. As explained in more detail
below, platform 106, or objects placed on platform 106, may have
various configurations to simulate various surgical procedures at
various positions inside the model. In this way, the single model
101 can be used for surgical port training for various different
surgical procedures.
[0039] The anatomical model 101 can also be useful for a range of
other surgical task exercises. For example, the model can be used
for remote center alignment of instruments with the abdomen body
wall, instrument exchange, camera and instrument insertion under
direct vision, other training activities related to patient side
skills (suture exchange using a laparoscopic tool, retraction using
a laparoscopic tool by an assistant, etc.), understanding and
illustration of workspace limits by the surgical instruments, setup
conditions to avoid collisions of external robot arms, etc.
[0040] FIG. 2A is a diagrammatic perspective view that illustrates
surgical ports in the model and associated cannula supports. In
this example, a cannula support piece 201 is placed below and
aligned with a set of the holes 103, 104 to simulate the patient's
body wall. When a cannula is inserted through a hole 103 or 104 and
the associated piece 201, the piece 201 acts as a support for the
cannula and holds the cannula in a manner similar to the way a
patient's body wall supports a cannula (e.g., a little floppy). By
simulating the way a cannula is supported by a patient's body wall,
medical personnel may be trained in a realistic situation to
position, align, and dock a surgical robot manipulator to an
associated cannula.
[0041] In some examples, piece 201 may be made of various materials
such as foam or rubber (e.g., polyurethane). Different materials
having different properties (e.g., stiffness) may be used to
simulate different body wall characteristics at corresponding
locations on the model. For example, one material may be used to
simulate the umbilicus, and a second material may be used to
simulate the anterior abdominal muscles. In some implementations,
piece 201 is sized to have thickness to simulate the patient's body
wall thickness. A relatively thicker piece 201 may be used in a
relatively larger model 101 to simulate a relatively larger
patient, whereas a relatively thinner piece 201 may be used in a
relatively smaller model 101 to simulate a relatively smaller
patient. In a single anatomical model, cannula support thicknesses
may be varied for one or more associated holes 103 to simulate
different body wall characteristics (e.g., umbilicus vis-a-vis
abdominal muscle).
[0042] Piece 201 may be supplied without any perforations, so that
piece 201 must be pierced to insert a cannula. Alternatively, the
piece 201 may be supplied with one or more preformed openings 202
through which the cannulas can be placed. The preformed openings
202 allow piece 201 to be reusable. As shown in FIG. 2A, in some
embodiments the preformed openings 202 may be single slit or cross
slit implementations. Alternatively, other openings such as
circular shapes of one or more diameters may be used. In some
implementations, such as implementations in foam, a thin protective
plastic layer may be placed on top surface 203 of piece 201 in
order to increase its service life during training.
[0043] As illustrated in FIG. 2A, in some embodiments the
anatomical model is configured to allow cannula support piece 201
to be removable from the top portion of the model. As shown, a
piece 201 can be inserted into a support bracket 204 that
underlies, for example, holes 103 or 104. A piece 201 can be cut to
the shape of a support bracket 204, for example. In some
implementations, a piece 201 can be disposable after one or more
uses. The support brackets 204 underlying particular sets of holes
may be identically sized, so that a piece 201 may be inserted into
one of two or more brackets 204. Alternatively, two or more
brackets 204 may be differently sized, so that a different cannula
support piece 201 is required for different corresponding sets of
holes. In other embodiments, a support piece 201 may be permanently
attached under a set of holes. In some embodiments one or more
support brackets 204 may have one or more openings 205 that allow a
cannula or an instrument to extend through the support piece 201
and into the interior space within the model. In other embodiments,
one or more support brackets 204 are solid, so that a cannula or
instrument cannot extend beyond the support bracket.
[0044] In some model 101 embodiments, different cannula support
types are used for different sets of holes. For example, one
cannula support type is used for a set of holes used for endoscope
insertion, and a second cannula support type is used for a set of
holes used for tissue instrument insertion. In one example
implementation, a foam type cannula support is used in association
with holes 104, and a different cannula support type is used in
association with holes 103.
[0045] FIG. 2B illustrates a second embodiment of the anatomical
model and associated cannula supports. As shown in FIG. 2B, top
portion 102a is configured with a plurality of window openings 206
that are relatively larger than holes 103 or 104. Each cannula
support piece can be inserted in a corresponding support bracket
204 below the surface of top portion 102a and underneath holes 103
and 104, similarly as described above for FIG. 2A. A benefit of
such relatively larger window openings 206 is that they allow a
relatively more free port placement than embodiments in which port
placement is constrained by the specific locations of the holes 103
or 104. In some embodiments, a thin membrane 207 (shown above the
top portion 102a in an exploded view) is placed over the openings
to simulate skin on the model. A pattern of port locations 208 may
be marked on membrane 207, each location being over an opening 206.
Various different membranes 207 may have various different port
location patterns 208 (e.g., one pattern per membrane, or two or
more patterns per membrane) to act as port placement guides for
various different surgical procedures. Such membranes 207 may also
include anatomical landmarks along with the port placement guides
to illustrate spatial relationships between the ports and the
landmarks. In some embodiments, a membrane 207 is used together
with an anatomical model having the relatively smaller cannula port
placement holes, such as holes 103 and 104.
[0046] FIG. 3A is a perspective view of another example embodiment
of a cannula support that may be used in the anatomical model. In
one implementation of the anatomical model, a cannula support 301
is aligned with and placed in each hole 103.
[0047] In the depicted implementation, cannula support 301 is a
flexible piece (e.g., rubber) sized to fit into holes 103 in the
model. Support 301 includes grips 302 around the outer perimeter to
prevent or reduce dislodgement of the support from its associated
hole 103. The support 301 includes an annular inner membrane 303
that covers a portion of a hole 103, and a hole 304 in the center
of the membrane 303. A cannula is inserted through hole 304, and a
friction fit between the inserted cannula and the membrane supports
the cannula. As described above, a cannula inserted through support
301 is a little floppy, which provides realistic simulation and
associated training benefits. Support 301's dimensions (e.g.,
thickness) and material characteristics (e.g., stiffness) may be
varied to produce a simulation of different cannula support
characteristics at various anatomical positions as described
above.
[0048] To assist in training, similar cannula supports 301 may be
distinguished from one another by various characteristics, such as
markings (e.g., letters, numbers, and the like) or colors. Supports
301 having a particular identifying characteristic are placed in
certain holes to aid instruction in proper port locations for
particular scenarios. For example, in an array of black colored
supports 301 in holes 103, red colored supports 301 may be placed
in a first pattern of holes 103 that correspond to proper port
placement for a prostatectomy, or the red colored supports 301 may
be placed in a second pattern of holes 103 that correspond to
proper port placement for a partial nephrectomy.
[0049] FIG. 3B is a perspective view of another embodiment
including a cannula support 301 and single site piece 310 that may
be used with the anatomical model. Cannula support 301 can be
similarly implemented as described above for FIG. 3A, which can be
designed to accommodate a single site piece 310. Single site piece
310 can be a supplemental piece used for guiding multiple cannulas
or instruments through a single hole 103 or 104. For example,
single site piece 310 can be a flexible (e.g., rubber or similar
material) cup-shaped piece as shown in FIG. 3B including multiple
holes 312, each hole for guiding a cannula or instrument, such as a
curved cannula 314 inserted in hole 316. In some implementations,
the single site piece 310 can also include an interior cup portion
320 for securing the single site piece 310 to the anatomical model
and/or further guiding the cannulas or instruments. FIG. 3C is a
perspective view of an example of three cannulas 322 (disconnected
from instruments and manipulators in this example) inserted through
a single hole of the anatomical model 101 using a single site piece
310.
[0050] It should be noted that although anatomical model 101 is
generally described as a shell having a hollow interior, with one
or more cannula supports being positioned in relation to the shell
so as to support one or more cannulas inserted through the shell,
in some embodiments an anatomical model may be made without a
hollow interior so that the model provides the cannula support
function but not the surgical site simulation function. For
example, foam or other material may fill the anatomical model's
interior. Or, the model may be made of a single, solid piece, such
as molded plastic or wood. In such embodiments, a support piece 201
may be inserted into a corresponding opening in the anatomical
model, which acts as a support bracket 204, or other cannula
supports such as supports 301 may be positioned on an outer surface
of the model with sufficient underlying space to allow a cannula to
be inserted into and held by the cannula support.
[0051] FIG. 4. is a top perspective view of an embodiment of the
anatomical model 101. As shown, top portion 102a includes several
holes 103, and each hole 103 has a support 301 inserted in it. Top
portion 102a also includes several holes 104, and a portion of a
foam piece is placed under and cover each hole 104. In the depicted
embodiment, one or more foam pieces 401 similar to piece 201
described above are permanently mounted under each hole 104 (e.g.,
with screws, as shown), and a protective plastic covering is used
with preformed cross slits visible over each foam piece 401. Thus,
the embodiment shown in FIG. 4 is reusable. Three illustrative
operating instrument cannulas 402 are shown placed in associated
supports 301 in holes 103. Although not shown, a camera instrument
cannula may be similarly placed in the foam support at a hole 104.
A relatively larger hole 104 (not shown) can in some
implementations be placed in top portion 102a (e.g., at a location
simulating the umbilicus) to allow training for single port access
to a surgical site. In some examples, the introduction of curved
cannulas and the required mounting to an associated robotic
manipulator can be tasks that may require training as provided by
anatomical model 101 and methods described herein.
[0052] In some implementations of the anatomical model 101, a top
surface 403 of top portion 102a can include one or more marked
target locations which can act as simulated anatomy locations of a
patient. In some implementations, top surface 403 of top portion
102a is formed to allow such markings to be erasably made (e.g.,
using grease pencil, white board marker, etc.). Such markings allow
a training person to draw on or mark the top portion 102a to assist
training and to help medical personnel understand port placement
philosophy, such as to mark port relationship relative to one
another (e.g., operating instrument port spacing from camera
instrument port) for various different surgical procedures. An
overlying membrane, such a membrane 207 (FIG. 2B) may be similarly
made to allow such erasable marking. In other implementations, the
marked locations are fixedly made to the top surface for standard
surgical procedures that are commonly trained using the model
101.
[0053] In training exercises, the marked locations can be used to
determine which holes 103 and 104 should be used with reference to
the marked target locations. In some example implementations of
trainee selection of proper port holes, a location can be marked to
simulate a location of a standard pelvic anatomy feature of a
patient, and the trainee then can be required to determine which of
the holes 103 and 104 are to be used for cannulas in a particular
surgical procedure on that pelvic location. In one example of
particular port placements, proper placement of a camera instrument
port should be 10-20 cm away from the target location, operating
instrument ports should be 8-10 cm from the camera port and other
operating instrument ports, and an accessory port should be at
least 5 cm away from other ports. Similarly, another location on
top portion 102a can be marked for an enlarged pelvic anatomy,
another location can be marked for a lateral quadrant anatomy, etc.
A trainee's performance in properly selecting and placing the
cannula ports can be measured, as in the training procedures
described below.
[0054] In some implementations, at least a portion of the outer
shell of anatomical model 101 is made transparent to allow a person
being trained to view a target surgical site within the model's
hollow interior and the relation between the target surgical site
the cannula port placements and robot manipulator positions that
are required to properly reach the target surgical site. For
example, top portion 102a may be made of a clear plastic material.
Likewise, an overlying membrane such as membrane 207 (FIG. 2) may
be made transparent for a similar purpose.
[0055] FIG. 5 is a diagrammatic top view of possible port placement
grids 501 for an overlying membrane. In some implementations, one
or more grids 501 are placed on a thin membrane 207 that covers top
portion 102a of the model. The membrane 207 covers the holes
103,104 (alternatively, window openings 206), and so allows a
person being trained to identify proper port placement in an
appropriate hole (or one or more holes) of the one or more grids
501. In some embodiments, the membrane includes one or more
anatomical features, such as the umbilicus, costal margins, or the
xyphoid process, and these anatomical features provide anatomical
references that help medical persons understand port placement.
Similar anatomical feature markings may be placed directly on the
top surface 403 of the anatomical model. Such features allow a more
realistic simulation of a patient. Membrane 207 may be marked as a
surgeon would mark a patient when determining port placement during
actual surgery. When port locations are selected on membrane 207,
the membrane can be pierced and cannulas inserted though the
nearest underlying holes 103,104 or through windows 206.
[0056] Once cannulas are in place in a patient body wall, a
surgical robotic manipulator can be coupled ("docked") to each
cannula, so that the manipulator controls both the cannula and an
instrument that extends through the cannula and into the patient to
reach the surgical site. FIG. 6 is a perspective view of an
exemplary surgical robot 601 with each manipulator (one for a
camera instrument and three for operation instruments, as shown)
coupled to an associated cannula in the anatomical model. A camera
instrument 602 can be positioned through a cannula in a centerline
hole 104, and the operation instruments 603 are positioned through
cannulas in holes 103, one on one side of the model and two on the
other side of the model (one is partially hidden). To enhance the
simulation of working on a patient in a surgical operating room
environment, model 101 is placed on an operating table 604 at a
location corresponding to a patient's position on the table.
Different surgical procedures require various different port
placements, and so a person being trained may have to position the
robot 601 in one location for one procedure (e.g., at the foot of
the operating table as shown, simulating a location between the
patient's legs) and in a second location for another procedure
(e.g., beside the operating table). In some implementations,
anatomical model 101 may include additional anatomical features,
such as appendages or portions thereof (e.g., legs, arms), other
anatomical areas (e.g., head and neck, upper torso), and natural
orifices (e.g., mouth, anus, vagina) to help a person being trained
understand how patient position and orientation, table position and
orientation, cannula placement requirements, target surgical site
location(s), and robotic manipulator position and orientation are
interrelated in order to provide the most effective access to a
desired surgical site.
[0057] In some examples of surgical robotic systems, a trainee
surgeon can teleoperate the surgical instruments 602 and 603 from a
separate console (not shown) that includes various controls
providing signals to the surgical robot 601 to allow manipulation
of the instruments in various ways. For example, various actuators
in robot 601 and controlled by the console signals can drive
movement of the instruments to perform surgical tasks. Other
control systems can be used in various implementations.
[0058] FIG. 7 is a perspective view that shows platform 106 in more
detail, and how platform 106 is positioned within the hollow
interior space of anatomical model 101. In one aspect, various
platform 106 embodiments are made, each embodiment corresponding to
one or more different surgical procedures at different simulated
surgical site locations. For example, one platform 106 embodiment
may have a simulated surgical site located relatively more
cranially than another platform 106 embodiment having a simulated
surgical site located relatively more caudally. Two or more
simulated surgical sites may be located on a single platform 106 to
simulate situations in which cannulas must be positioned to provide
effective endoscopic camera and tissue instrument access to the two
or more sites, or to demonstrate that in certain circumstances one
set of cannula positions is required to effectively access one
surgical site, and a second set of cannula positions is required to
effectively access a second surgical site. In some circumstances,
physical limitations of the instruments and/or associated robot
manipulators may indicate that one set of cannula positions
required to access one surgical site at a first anatomical location
(e.g., lymph nodes in the lower abdomen), and a second set of
cannula positions is required to access a second surgical site at a
second anatomical location (e.g., lymph nodes in the upper
abdomen). Consequently, in such circumstances the robot
manipulators must be decoupled ("undocked") from cannulas in the
first setoff positions, cannulas are then inserted in the second
set of positioned, and the robot manipulators are then docked to
the cannulas in the second set of positions.
[0059] Platform 106 embodiments may also be configured to place a
simulated surgical site at various depths within the model so as to
simulate working relatively near the body wall through which the
cannulas are inserted (e.g., anterior access to anteriorly located
tissue) or relatively far away from the body wall through which the
cannulas are inserted (e.g., anterior access to posteriorly located
tissue).
[0060] A platform 106 can be removably placed within a fixture (not
shown in FIG. 7) in base 102b, and the fixture acts as a fixed
registration location for the associated required port placement.
Thus when a platform is selected and positioned in the model, the
platform is located at a constant position. Thus the model
positions surgical task exercises in the same location inside the
abdomen model across surgeons or between training sessions to
enable consistent and repeatable comparison of trainee performance,
and persons being trained can be evaluated to ensure that port
placements they select are effective for the type of surgical
procedure being simulated by the selected platform.
[0061] As shown in FIGS. 7 and 8, various platform 106 embodiments
can each be configured to simulate a surgical site. As shown in
FIG. 7, for example, platform 106 may be configured with one or
more structures at various locations, such as pegs 701. FIG. 8 is a
perspective view of a platform 106 embodiment that is configured
with several openings 801 that can accommodate surgical task
training components at various positions and/or orientations on a
platform 106. A simulated surgical task can be carried out by
placing one or more objects (e.g., small rings) in relation to the
structures or openings, such that the structures or openings can
act as templates for exercises. In another aspect, a common
platform 106 is configured to accommodate various removable
components that simulate a surgical site. In these aspects, one or
more structures or openings (e.g., pegs 701, openings 801, or
holder 902 (FIG. 9)) are used to consistently position removable
surgical site simulation components on platform 106 and thus
consistently position the components in model 101.
[0062] FIG. 9 is a perspective view of base portion 102b with
platform 106 mounted. Platform 106 is aligned in base portion 102b
by positioning it inside alignment guides 901. A surgical task
exercise holder 902 is fixed to platform 106 or may be an
integrated part of platform 106. Various surgical task exercise
holder 902 embodiments exist, such as guide rails (as shown),
releasable fasteners (e.g., hook and loop (Velcro.RTM.) fasteners,
3M Company's Dual Lock.TM. fasteners), magnets, re-adherable
adhesives, and the like). Various surgical task exercise components
903 may be inserted into and held by holder 902 at a known,
constant position and orientation, so that exercises are
consistently registered by location within the anatomical
model.
[0063] Embodiments of surgical task exercise holders may include
two or more components, such as one component coupled to platform
106 and a second component coupled to the first component. FIG. 10
is a perspective view and shows a second surgical task exercise
holder component 902a, which slides between and is held in place by
the rails of the first component which is the exercise holder 902
of FIG. 9. A surgical task exercise holder 902 can hold one or more
various surgical task exercise components such as component 902a.
Such surgical task exercise components may be permanently coupled
to an associated exercise holder, or they may be removably coupled
to an associated exercise holder in a manner similar to the way an
exercise holder may be removably coupled to platform 106.
[0064] FIG. 10 is a perspective view of another example embodiment
of the anatomical model 101 and a platform 106 similar to the
embodiment shown in FIG. 8. Platform 106 includes a surgical site
component 1002 positioned at one end. The platform 106 can be
inserted into an open end of the anatomical model 101 as shown. For
example, the platform 106 can be slid until secured in a known
position within the anatomical model 101.
[0065] FIG. 11 is a perspective view of an example interior of one
embodiment of an anatomical model 101. A platform 106 similar to
the one shown in FIG. 10 has been inserted and has been secured in
a known position with the interior, thus placing the platform in a
known position relative to the holes 103 and 104 in the top portion
of the model 101. In some implementations, the platform 106 can be
secured in the known position by a plate 1102 that slides into a
locking position and is secured in that position by a fastener,
such as knob 1103 which can be screwed in placed by a trainee. A
simulated surgical site including component 1104 is provided on one
end of the platform 106 and is referenced relative to three
operating instruments 1105 that have been inserted through holes
103 and a camera instrument 1106 that has been inserted through a
hole 104. A trainee can control operating instruments 1105 to
manipulate the surgical site component 1104 similarly to a real
surgical site in a patient.
[0066] FIG. 12 is a perspective view of one example of an
illustrative task exercise component for a platform 106 similar to
the platform 106 of FIG. 8. Platform 106 of FIG. 12 includes
multiple openings 801 which are spaced apart by a predetermined
distance in multiple directions. An exercise component 1201 can
include a component base 1202 that holds the surgical site
component 1203 on a top side, and also includes a number of pegs
1204 on a bottom side of the base 1202. The pegs 1204 are spaced to
fit in the openings 801 of the platform 106. In this way, the
exercise component 1201 can be positioned in any of a variety of
known locations on the platform 106. Each of these locations is a
known location with respect to the holes 103 and 104. The selected
position on the platform 106 for the component 1201 can be input to
the robotic surgery system, for example. The exercise component
1201 can be any of a variety of types of components as described
below.
[0067] FIGS. 13A to 13H show several illustrative task exercise
components which can be used for platform 106, e.g., as exercise
component 903 of FIG. 9 or any of the surgical site exercise
components of FIGS. 10-12. For example, each task exercise
component can be removably mounted on holder 902 of FIG. 9 by, for
example, sliding under mounting rails 1001 of the component 1310 as
shown in FIG. 13E. Alternatively, each task exercise component can
be provided on a component base 1202 and inserted in openings 801
of platform 106 as shown in FIG. 12.
[0068] Exercise component 1301 of FIG. 13A, component 1302 of FIG.
13B, component 1303 of FIG. 13C, and component 1304 of FIG. 13D
involve moving small pieces such as rings or beads 1305 along a
curved pathway, such as a curved wire 1306. These curved pathways
1306 can be oriented vertically (as in components 1301 and 1302),
primarily horizontally (as in component 1303), or a combination of
these orientations (as in component 1304). For example, forceps or
claws on the tips of operating instruments can be used to grasp the
pieces 1305 and move them. In some implementations, features such
as the loops in component 1302 can require hand-off by a trainee
between two instruments, such as left hand and right hand
instruments.
[0069] Exercise component 1310 of FIG. 13E can be a portion of soft
material (e.g., foam) to simulate tissue for manipulation tasks.
For example, component 1310 can be a piece 1311 of foam having
multiple holes 1312. In some surgical tasks, the trainee can be
required to insert a curved needle in the holes to perform sutures.
FIG. 13F shows a closeup view of a portion of component 1310 used
for a suturing task, where a claw 1313 attached to an operating
instrument manipulated by a trainee is routing a suture thread 1314
through holes 1312.
[0070] Exercise component 1320 of FIG. 13G can include a tubular or
ring-shaped portion of soft material (e.g., foam) to simulate a
structure often treated by surgeons. Tube piece 1321 can be held to
the platform 106 by a support 1322. An opening 1323 of the piece
1321 can be exposed to allow a trainee to close the opening with
sutures. FIG. 13H shows a closeup view of the tube piece 1321 in
which a trainee has closed the opening 1322 with suture thread
1323.
[0071] Various exercise components 903 may be used to simulate
various surgical tasks; components of FIGS. 13A-13H are merely
illustrative. The abilities to easily and quickly remove and insert
a platform in the anatomical model and change exercise components
using platform systems such as shown in FIGS. 7-12 allows the
anatomical model 101 to be easy to use, offering a large amount of
surgical exercises for training while maintaining standardized port
locations and robot setup across all exercises performed by the
trainee.
[0072] In some implementations, while a surgical robot is coupled
to cannulas inserted in the anatomical model, a platform 106
embodiment may be removed from the model (e.g., without undocking
the robot manipulators from the associated cannulas or removing the
endoscopic camera and tissue instruments from their associated
cannulas). Then, either the removed platform 106 is reconfigured
with another exercise component 903 or the removed first platform
106 is replaced by a second platform 106 with a second exercise
component 903, so that a trainee must evaluate port placement in
view of a task associated with the reconfigured or new platform
106. For example, one platform 106 embodiment may represent
prostate location, which requires one set of port placements, and
another platform 106 embodiment may represent upper abdomen lymph
node location, which may require a second set of port placements.
Since the platform 106 positions are the same with reference to
base 102b (i.e., within the anatomical model), the surgical site
locations are in their correct relative anatomical locations with
reference to the anatomical model. If a trainee chooses an
incorrect port placement pattern and is then required to complete
the associated exercise task, the problems associated with the
incorrect port placement (e.g., robotic manipulator collisions,
instruments interfering with one another, inability to reach
certain locations at the surgical site, proper camera position for
viewing the surgical site during the operation, etc.) are
highlighted and evaluated.
[0073] The features of the anatomical model allow a trainee to be
scored during the training process, so that performance and
improvement can be measured. In addition, a trainee can be scored
in relation to other trainees or in relation to historic data in
order to determine how well the trainee can perform the required
task. Also, aggregate historical scoring may reveal that trainees
have difficulty performing a certain task, and so training can be
modified to improve a training program for that task.
[0074] In some examples, there can be two main categories of the
training process. One skill category can be associated with actions
physically near the patient's location (e.g., robot manipulator
position and orientation setup, cannula port placement, docking,
and the like)--so called "patient side" activities. The second
skill category can be associated with performing the surgical task
(e.g., telerobotically or manually positioning an endoscopic camera
and moving tissue instruments at the surgical site). Parameters
associated with these two categories may be evaluated to measure
trainee improvement or to compare one trainee's performance
parameters to corresponding parameters demonstrated by other
trainees (concurrent or historic) or by persons considered to have
expert skill levels. Thus a trainee's skill level in a particular
parameter may be evaluated relative to peers (e.g., to determine
the trainee's progress with reference to anticipated improvement)
or relative to experts (e.g., to identify deviations from a high
skill level). For patient side skills training, a trainee may be
scored, for example, on how well port placement is selected for a
selected surgical procedure, or how long it takes to determine the
correct port placement. Or, a trainee may be scored on how the
surgical robot is coupled to the placed cannulas (concerning, for
example, manipulator arm collision avoidance) or how long it takes
a trainee to couple the manipulators to the cannulas.
[0075] In one aspect, a trainee skill level associated with a
specified parameter is automatically scored by using information
obtained from a surgical robotic system. In a typical surgical
robotic system, various sensors (e.g., joint position sensors,
servo motor position encoders, fiber Bragg grating shape sensors,
etc.) are used to determine kinematic information (position and/or
orientation) associated with the robot manipulators. Consequently,
a surgical task exercise scoring system may use the robot kinematic
information to determine positions and orientations of instruments
directed during an exercise, and thereby determine if a trainee has
properly selected ports for a specific surgical task exercise. As
an example of such a scoring system, a kinematic setup template is
created that defines a specific effective robot manipulator
position and orientation for a specific surgical task. Data
associated with a trainee's surgical task exercise performance is
compared against the template to create a performance score. For
example, a task exercise time parameter may be measured by starting
a timer at the beginning of a cannula docking exercise and stopping
the timer when the surgical robotic system senses that all
manipulators have been properly docked to an associated cannula. As
another example, a task exercise robot manipulator collision
avoidance parameter may be measured by comparing kinematic
information from each docked robot manipulator against template
kinematic information to determine how close a trainee has come to
placing the manipulators in prescribed ideal positions and
orientations or within prescribed position and orientation
envelopes. Similarly, kinematic information from the robot
manipulators, in conjunction with known physical dimensions of an
anatomical model 101 (which may be various sizes, as described
above) can be used to determine if a trainee has properly
positioned the cannulas in a correct port placement pattern, or if
the remote center of motion for each cannula (the location on each
cannula that stays stationary in space as the manipulator moves) is
correctly positioned so as to minimize tissue trauma at a patient's
body wall. For any evaluation, metrics may be sampled during the
exercise to indicate a trainee's performance as he or she completes
the exercise, and these intermediate evaluations may be plotted
against a template to obtain a score. For example, historic data
may indicate that specific acts should be completed in a certain
order in order to most effectively complete a task, kinematic data
may be used to show the actual order in which a trainee performed
the acts, and differences between the recommended versus actual
order of acts completed is used to determine a trainee's score.
[0076] FIG. 14 is a flow chart illustrating an example method for
evaluating surgical task exercises. The example surgical exercise
depicted in FIG. 14 is associated with the first category of
training categories, patient side (e.g., setup) operations.
[0077] In block 1401, an anatomical model 101 is selected, a
desired surgical task is selected, and a platform 106 associated
with the selected surgical task is inserted inside the anatomical
model. The platform 106 is provided with a simulating training
exercise site selected to be appropriate for the surgical task and
which is positioned on the platform for port placement appropriate
for the surgical task through the holes 103 and 104 relative to the
site. In block 1402, the anatomical model is positioned on an
operating room table. Blocks 1401 and 1402 may be performed in any
order.
[0078] Blocks 1403, 1404, and 1405 are example exercise actions
generally for setting up a robotic surgical task, which are
performed by a trainee and measured by an evaluation component. In
block 1403, a trainee selects one or more ports for surgery for a
specific target anatomy represented by the model. For example,
camera cannulas and operating instrument cannulas can be placed so
that the desired surgical site portions are in view of a camera
instrument and are in operating range of operating instruments to
be placed in the cannulas. One or more cannulas can be placed in
one or more of the various holes in anatomical model embodiments
described above, for example. In block 1404, the trainee positions
surgical robot manipulators for docking in view of parameters such
as mutual manipulator collision avoidance and required instrument
range of motion. In block 1405, the trainee docks the robot
manipulators to the associated cannulas. During blocks 1403, 1404,
and 1405, an evaluation component of the exercise, e.g.,
implemented by one or more processors of the surgical robot, can
measure parameters associated with the tasks performed by the
trainee, such as the overall completion time of all tasks in blocks
1403 to 1405, completion time of particular tasks, the position and
orientation of manipulators, as well as other parameters of the
actions taken by the trainee. Performance parameters (and metrics
determined from the parameters) can be measured at multiple times
during the performance of blocks 1403-1405.
[0079] In block 1406 an automatic evaluation of the surgical task
is completed. For example, the automatic evaluation can use
kinematic information from the robotic surgical system obtained
during the performance of blocks 1403, 1404, and 1405. Such
kinematic information can use remote center positions of the
surgical instruments and setup joint values. The kinematic
information can be compared to a template of desired or ideal
kinematic information to determine if robot manipulator setup
joints and other structures are properly configured to place the
associated robot manipulators at a proper position and orientation,
and if cannula ports are properly positioned and spaced to allow
effective surgical site access with minimized manipulator collision
avoidance. The ideal template information can be, for example,
clustered or averaged positions, movements, and/or placements from
prior performances of trainees and/or experts, or known optimal
positions for instruments, robot components, etc.
[0080] As described above, in some implementations, the trainee's
performance metrics for various skill parameters are based on
measurements made at multiple times during the exercise. In some
implementations, the individual trainee's performance can be
compared to previous or historic performance data for that trainee
and/or compared to historic performance data from other trainees
and/or from experts to evaluate the trainee's relative learning
speed and effectiveness and/or determined the trainee's skill
level.
[0081] In block 1407, the results of the evaluation are output. In
some examples, the results can be one or more scores that indicate
a performance level or skill of the trainee based on the
performance in blocks 1403-1405. Some implementations can provide
graphical feedback indicating the level or skill. For example,
graphical diagrams can be displayed on a display device indicating
how close the robot manipulators are positioned to ideal or correct
positions for the surgical task. Furthermore, some implementations
can output real-time feedback during the performance of blocks
1403-1405, such as indicators of correct or incorrect placements
and positions of surgical instruments, hints to the trainee,
graphical indications of correct positioning and orientation and
the acceptable range of motions and placements for particular
instruments, etc. Some real-time feedback can be instructional,
indicating where instruments should be placed or positioned. The
robotic system, anatomical model, and trainee evaluation features
can also be used to provide tutorials to persons, demonstrating how
to select ports, position the robot, and dock robot arms.
[0082] In block 1408, various further actions may be taken to
continue training, such as removing one platform 106 and replacing
with a second platform 106 or second surgical task exercise, as
described above, either with or without undocking the robot
manipulators from the cannulas, and then the process may return to
1102 or other earlier block as appropriate.
[0083] Other patient-side tasks can also or alternatively be
included in the exercise actions of blocks 1403-1405. For example,
static registration techniques can be trained, which are used to
determine the location of the abdomen model in space relative to
surgical robot system components such as one or more instruments of
the surgical robot 601. In some examples, static registration can
include touching the anatomical model 101 in three or more known
locations of the model with one of the robotic arms while recording
the kinematic information sensed by sensors of the arms. This
kinematic data can be used to determine the 3D location and
orientation of the anatomical model relative to the robot system.
For example, this allows the system to more easily determine the
ports and model locations which a trainee is using and to provide
directed feedback, evaluation, and scoring on such ports and how to
move to the correct ports, if necessary.
[0084] FIG. 15 is a flow chart illustrating another example method
for evaluating surgical tasks. The example surgical exercises
depicted in FIG. 15 are associated with the second category of
training categories, surgical task operations performed at the
surgical site in the anatomical model.
[0085] In block 1501, an anatomical model 101 is selected, a
desired surgical task is selected, and a platform 106 associated
with the selected surgical task is inserted inside the anatomical
model. The platform has a training surgical site selected and
positioned as appropriate for the selected surgical task. In block
1502, the anatomical model is positioned on an operating room
table. Blocks 1501 and 1502 may be performed in any order.
[0086] In block 1503, a trainee selects ports for surgery
associated with specific target anatomy, inserts the appropriate
cannulas into the anatomical model 101, positions the robot
manipulators, and docks the robotic manipulators to the associated
cannulas. In some implementations, such patient-side actions can be
measured in block 1503, as described above with reference to FIG.
14.
[0087] In block 1504, the trainee performs the simulated training
exercise at the simulated surgical site inside the anatomical
training model by teleoperating the robotic surgical instruments
inserted through the cannulas. An example training exercise may be
ones illustrated by components of FIGS. 13A-13H described above
(e.g., suturing, manipulating objects, etc.), or one or more other
simulated tasks. In some implementations, parameters are measured
during the performance of block 1504, such as completion time of
one or more tasks of the exercise, and robot kinematics for
computing metrics (e.g., movement volume, errors in the exercise,
economy of motion of the instruments, etc.). Performance parameters
(and metrics determined from parameters) can be measured at
multiple times during the performance of block 1504.
[0088] In one example, if using a component such as shown in FIGS.
13A-13D at the surgical site, a training procedure can require that
the trainee pick up a ring 1305 with an operating instrument, move
the ring along the pathway 1306 to a finish position (transferring
the ring to another instrument controlled by a different hand as
needed) without dropping the ring 1305, while moving the camera to
keep the ring and instrument tips in the center of view at all
times, and while repositioning controllers to keep the trainee's
hands in central controlling positions. In another example, if
using a suturing exercise component such as components of FIGS.
13E-13H, the trainee can be required to drive a needle in a
predetermined pathway of suture holes in the component while
keeping the site in view of the camera, or suture an opening closed
with spatial requirements as to the locations of the sutures.
[0089] In block 1505, an automatic evaluation of the surgical task
is completed. For example, parameters such as overall completion
time and robot manipulator movements (e.g., within a particular
range of motion envelope) can be scored against template values
considered to be the correct parameters. Parameters that may be
evaluated may include overall completion time, time to complete a
particular training exercise and/or one or more stages within an
exercise, errors made (e.g., dropping an item, breaking a suture,
etc.) while completing the exercise, the volume covered by control
inputs during the exercise, economy of control input motion, and
frequency of moving the endoscope instrument during the task.
[0090] In block 1506, the results of the evaluation are output
indicating an estimated level or skill of the trainee for the
evaluated surgical exercise. Similarly as described above for FIG.
14, some implementations can provide graphical feedback, e.g.,
indicating how close the operating instrument end effectors are to
ideal or correct positions for the surgical task, and/or ideal
locations for sutures, cuts of tissue, etc. Furthermore, some
implementations can output real-time feedback during the
performance of blocks 1504, such as indicators of correct or
incorrect sutures, instrument positions, hints to the trainee, etc.
Some real-time feedback can be instructional, indicating how
instruments should be placed, moved, or positioned.
[0091] In block 1507, various further actions may be taken to
continue training, such as removing one platform 106 and replacing
with a second platform 106 or second surgical task exercise, as
described above, either with without undocking the robot
manipulators from the cannulas. The process may return to a
previous block, e.g., block 1502, 1503, or 1504, as
appropriate.
[0092] Upon completion of an exercise, the metrics may be displayed
to the trainee in the output block 1506 so that the trainee can
monitor his or her progress, or can compare his or her performance
against other persons from a novice to expert range. The anatomical
model 101 facilitates such automated performance tracking because
it allows repeatable and standardized placement of simulated
training exercises regardless of instructor or trainee. Current
anatomical models are inadequate for such standardized evaluation,
and aspects described herein facilitate the required
standardization to ensure that the exercises are identically
configured for each use, thus ensuring standardized training
evaluation against peers and experts. In some implementations,
parameters and metrics can be displayed in real-time to the trainee
during the performance of an exercise in block 1504.
[0093] Although the above methods in FIGS. 14 and 15 refer to
measuring and evaluating performances from a single trainee, these
methods can also be used to measure and evaluate performances of
multiple trainees at once and in various roles during a training
exercise. For example, the anatomical model and surgical robot
system can provide training for teams of persons, such as one or
more surgeons, assistants, nurses, etc. In some examples, one or
more assistant trainees can perform patient-side surgical tasks for
the method of FIG. 14 and a surgeon trainee can perform surgical
operations in the method of FIG. 15 while operating a console.
Trainees other than the surgeon can use the abdomen model to
practice patient-side skills (e.g. port placement, docking, system
setup, camera and instrument insertion) since they will often
perform these activities in the operating room. The team can also
train their communication to perform and coordinate various tasks
such as exchange instruments, adjust ports, pass sutures using a
conventional laparoscopic tool, coordinate a uterine manipulator to
assist the console surgeon, etc.
[0094] In some implementations providing training for such teams of
trainees, the evaluation and scoring methodology described above
can be extended to evaluate the performance of operating room teams
in addition to individual trainees. For example, various scores can
be output indicating the performance level or skill for coordinated
team tasks. Such evaluation can be assisted by automated metrics to
track progress and compare to historical data similarly as
described above. These features can help provide proficiency
standards for teams to understand their efficiency and how they can
improve.
[0095] The accurate tracking and comparison of a person's skill
level as described above in the described training methods can
provide important metrics useful in a variety of contexts. For
example, certifying bodies, such as hospital credentialing
committees, may use trainee evaluations and metrics to decide if a
person is qualified for various medical practice areas or programs,
such as performing robotic or manual minimally invasive surgery or
qualifying for medical residency programs. Industry and academic
researchers may also use such metrics to determine the relative
effectiveness of various training programs or personnel actions
associated with the anatomical model's capabilities, so that
improved training methods and improved robotic platform
configurations may be developed. Standardized port placement and
exercise positioning as trained using disclosed features allows for
comparison between subjects and quantification of results that can
be included in summary documentation submitted to the Food and Drug
Administration (FDA) or other governmental or controlling
organizations. The standardization also allow consistent trainee
setups and scenarios to be experienced by different users, enabling
understanding of how they use the system and how certain features
of the system can be improved, which in turn can be important for
required testing of surgical systems as well as designing
improvements to the systems. In a manufacturing context, such
techniques also allow consistent and repeatable tests for systems
coming off of an assembly line and ensure that all such systems are
tested the same way. Such techniques also enable certain exercises
to be directly replicated in a computer-simulated environment
(e.g., ring manipulation) and used for side-by-side comparisons of
computer simulation (dry-lab) and the physical simulation used in
the training exercises. This can be important for computer
simulation development to ensure a computer-simulated environment
represents real world dynamics appropriately and teaches the
trainee the proper skills (e.g., no negative learning). Direct
side-by-side comparisons of this kind have been difficult in the
past because a standardized setup for the physical exercises was
difficult to achieve.
[0096] Furthermore, the anatomical model with multiple port
locations enables clinical development engineers and surgeons to
explore and develop new and advanced port placement options for
various surgical procedures without requiring a porcine model or
actual patient. This enables more thorough exploration and
understanding of how new and improved port placements can be
discovered. It also can help define procedure-recommended port
locations for new surgical instruments, new robotic systems,
etc.
[0097] FIG. 16 is a diagrammatic view that illustrates aspects of
an example system 1600 which can be used for surgical exercise
tasks and automated evaluation and scoring of surgical task
exercises. As shown in FIG. 16, a medical device 1601 is used,
which can be a robotic surgical system or other system that is
capable of providing data concerning the position and/or
orientation of one or more medical devices, such as a system
including surgical robot 601. The medical device 601 provides
kinematic information 1602 to be stored in a memory 1603 that is
included in a scoring system 1604. Kinematic information 1602 can
include performance parameters for a trainee's performance, as
described above. Information 1602 may be provided, for example, via
an application program interface (API) interface in a surgical
robotic system. The kinematic information 1602 can be provided from
a patient-side cart component (e.g., including cannulas, arms, and
other features as shown in FIG. 6), and or the information 1602 can
be provided from other components of the surgical robotic system,
such as kinematic information describing position and/or
orientation of controls for a operator (such as a surgeon or
trainee) on a surgeon console used to manipulate surgical
instruments provided on the patient-side cart. For example, such
controls can include levers, joysticks, knobs, or other
manipulandums moveable by the operator in one or more degrees of
freedom.
[0098] In some embodiments, anatomical model information 1605
(e.g., physical dimensions, locations of possible cannula ports,
location of surgical manipulators or instruments, etc.) associated
with an anatomical model 101 is also input to the memory 1603. And,
template information 1606 is input into memory 1603, indicating
baseline, desired, and/or correct parameters and data for
comparison to trainee performance parameters. Other parameter
information can also be stored in memory 1603, such as data
processed from kinematic information 1602 and event data, e.g.,
recorded times related to trainee tasks and task completions, etc.,
and which can be collected and/or determined by other components of
system 1600 such as processor 1607, sensors of the system, etc.
Thus, memory 1603 as depicted is symbolic of one or more physical
memory locations that can store information that scoring system
1604 uses to carry out an evaluation of a trainee's performance.
Such an evaluation is executed by processor 1607, which is likewise
symbolic of one or more information processing devices (e.g.,
microprocessor(s) or other processing circuitry) that can be used
to carry out the evaluation.
[0099] The evaluation results, such as one or more scores and/or
other information, can be output via an output device 1608, such as
a visible display on a display screen or other display device, a
physical printout from a printer, or other output. The individual
exercise results may be added to historic data 1610 (e.g.,
depending on an input at operator selection input 1609), which in
turn may be used to modify template information 1606. In some
embodiments, an operator input device 1609 enables a training
system operator to input various selections related to training
exercises, such as identifying a particular surgical exercise task
to be carried out, and/or identifying a particular anatomical model
that is being used. The scoring system can automatically select the
appropriate information (e.g., proper template information 1606) to
use to carry out the evaluation.
[0100] Embodiments of a scoring system 1604 may be implemented, for
example, on a small computer system, such as a laptop computer or
other electronic device, or they may be embedded in surgical robot
systems (e.g., with outputs displayed via the robot system's
displays). Such scoring systems may also be networked to a central
database to facilitate data collection from a number of medical
devices and from a population of medical personnel (e.g., surgeons)
and to facilitate data and/or scoring comparison within the trainee
or surgeon population.
[0101] In addition to use for robotic surgical system training,
various features disclosed herein may be used for manual minimally
invasive surgery. Scoring aspects for training can be adapted for
training in such manual procedures, such as ability to reach
locations at the surgical site, instrument interference, camera
position, surgeon comfort, etc. Automated scoring aspects can be
based on sensing a position of one or more components, such as
cannulas, surgical instruments, etc. by various technologies such
as machine vision, three dimensional tracking, fiber Bragg grating
tether, electromagnetic position sensing, etc.
[0102] Features of anatomical models and surgical training methods
are disclosed herein. In various implementations, a standardized
anatomical model can provide a known configuration to be used for
surgical training. Holes and cannula support pieces can be placed
at known locations in the model. Various surgical task exercises
can be placed inside the interior of the anatomic model at known,
consistent locations. Standardized positioning allows training
metrics to be determined for various tasks, such as tasks
associated with setting up a surgical robotic system to perform a
specific procedure on a patient and tasks associated with carrying
out the procedure. Training methods associated with the use of the
standardized model allow specific parameters to be consistently
measured for a population of trainees or experts. A specific
trainee's measured parameters can be compared against the measured
parameters of peer or expert populations or other reference data,
and an evaluation can be determined and output. Furthermore, many
of the metrics that can be captured with the disclosed models and
methods are far greater in type and scope than what is measureable
in previous and traditional laparoscopic training exercises. This
can be of great advantage for analyzing, improving, and innovating
surgical procedures and equipment.
[0103] In the disclosure herein, the term "flexible" in association
with a part, such as a mechanical structure, component, or
component assembly, should be broadly construed. In essence, the
term means the part can be repeatedly bent and restored to an
original shape without harm to the part. Many "rigid" objects have
a slight inherent resilient "bendiness" due to material properties,
although such objects are not considered "flexible" as the term is
used herein. A flexible part may have infinite degrees of freedom
(DOF's). Examples of such parts include closed, bendable tubes
(made from, e.g., NITINOL, polymer, soft rubber, and the like),
helical coil springs, etc. that can be bent into various simple or
compound curves, often without significant cross-sectional
deformation. Other flexible parts may approximate such an
infinite-DOF part by using a series of closely spaced components
that are similar to a snake-like arrangement of serial "vertebrae".
In such a vertebral arrangement, each component is a short link in
a kinematic chain, and movable mechanical constraints (e.g., pin
hinge, cup and ball, live hinge, and the like) between each link
may allow one (e.g., pitch) or two (e.g., pitch and yaw) DOF's of
relative movement between the links. A short, flexible part may
serve as, and be modeled as, a single mechanical constraint (joint)
that provides one or more DOF's between two links in a kinematic
chain, even though the flexible part itself may be a kinematic
chain made of several coupled links. Knowledgeable persons will
understand that a part's flexibility may be expressed in terms of
its stiffness.
[0104] Unless otherwise stated in this description, a flexible
part, such as a mechanical structure, component, or component
assembly, may be either actively or passively flexible. An actively
flexible part may be bent by using forces inherently associated
with the part itself. For example, one or more tendons may be
routed lengthwise along the part and offset from the part's
longitudinal axis, so that tension on the one or more tendons
causes the part or a portion of the part to bend. Other ways of
actively bending an actively flexible part include, without
limitation, the use of pneumatic or hydraulic power, gears,
electroactive polymer (more generally, "artificial muscle"), and
the like. A passively flexible part is bent by using a force
external to the part (e.g., an applied mechanical or
electromagnetic force). A passively flexible part may remain in its
bent shape until bent again, or it may have an inherent
characteristic that tends to restore the part to an original shape.
An example of a passively flexible part with inherent stiffness is
a plastic rod or a resilient rubber tube. An actively flexible
part, when not actuated by its inherently associated forces, may be
passively flexible. A single part may be made of one or more
actively and passively flexible parts in series.
[0105] This description and the accompanying drawings that
illustrate features and implementations should not be taken as
limiting. Various mechanical, compositional, structural,
electrical, and operational changes may be made without departing
from the spirit and scope of this description and the claims. In
some instances, well-known circuits, structures, or techniques have
not been shown or described in detail in order not to obscure
described features.
[0106] Further, this description's terminology is not intended to
limit the scope of the claims. For example, spatially relative
terms--such as "beneath", "below", "lower", "above", "upper",
"proximal", "distal", and the like--may be used to describe one
element's or feature's relationship to another element or feature
as illustrated in the figures. These spatially relative terms are
intended to encompass different positions (i.e., locations) and
orientations (i.e., rotational placements) of a device in use or
operation in addition to the position and orientation shown in the
figures. For example, if a device in the figures is turned over,
elements described as "below" or "beneath" other elements or
features would then be "above" or "over" the other elements or
features. Thus, the exemplary term "below" can encompass both
positions and orientations of above and below. A device may be
otherwise oriented (rotated 90 degrees or at other orientations)
and the spatially relative descriptors used herein interpreted
accordingly. Likewise, descriptions of movement along and around
various axes includes various special device positions and
orientations. In addition, the singular forms "a", "an", and "the"
are intended to include the plural forms as well, unless the
context indicates otherwise. Components described as coupled may be
electrically or mechanically directly coupled, or they may be
indirectly coupled via one or more intermediate components.
[0107] Elements described in detail with reference to one
implementation may, whenever practical, be included in other
implementations in which they are not specifically shown or
described unless the one or more elements would make an
implementation non-functional or provide conflicting functions. For
example, if an element is described in detail with reference to one
embodiment and is not described with reference to a second
embodiment, the element may nevertheless be included in the second
embodiment.
[0108] The functional methods, blocks, features, devices, and
systems described in the present disclosure may be integrated or
divided into different combinations as would be known to those
skilled in the art. Disclosed methods and operations may be
presented in a specific order, but the order may be changed in
different particular implementations. In some implementations,
multiple steps or blocks shown as sequential in this disclosure may
be performed at least partially at the same time.
* * * * *